Difference between revisions of "Radiation changes"

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'''Radiation changes''', also '''radiation effect''', are seen occasionally by [[pathologist]]s. They are usually a result of prior treatments. The history is important in making this diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Radiation changes -- high mag.jpg
| Width      =
| Caption    = Radiation changes. [[H&E stain]].
| Micro      = cytoplasmic vacuolation (usually abundant), enlarged nuclei - but usu. normal [[NC ratio]], no nuclear membrane irregularies, chromatin "smudgy", +/-multinucleation, +/-fibrosis (chronic change), +/-edema (acute change)
| Subtypes  =
| LMDDx      = [[pleomorphic tumours]] - esp. [[sarcoma]]s, poorly differentiated carcinomas, drug/toxin effect, well-differentiated tumours in the background of radiation changes, "[[giant cell cystitis]]"
| Stains    =
| IHC        = Ki-67 low, pankeratin -ve (usu.)
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = pretty much anywhere
| Assdx      =
| Syndromes  =
| Clinicalhx = history of radiation treatment/exposure - important for the diagnosis
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = cancer recurrence, infection, new malignancy, post-surgical changes
}}
'''Radiation changes''', also '''radiation effects''', are seen occasionally by [[pathologist]]s. They are usually a result of prior (radiation) treatments. The history is important in making this [[diagnosis]].
 
==General==
*History of radiation treatment/exposure.
*Clinical symptoms dependent on site.


==Gross==
==Gross==
*+/-Fibrotic appearing tissue.
*+/-Erythema (early)
*+/-Fibrotic appearing tissue (late).


==Microscopic==
==Microscopic==
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*Cytoplasmic vacuolation - usually abundant.
*Cytoplasmic vacuolation - usually abundant.
*Nucleus:  
*Nucleus:  
**Enlarged nucleus - but '''normal NC ratio'''.
**Enlarged nucleus - but '''normal [[NC ratio]]'''.
**No nuclear membrane irregularies.
**No nuclear membrane irregularies.
**Chromatin: "smudgy".
**Chromatin: "smudgy".
Line 16: Line 50:


Important note:
Important note:
*The atypical cells are stromal cells; these survive the radiation.  The epithelium is usually normal in the context of chronic changes.
*Pleomorphism is often suggestive of malignancy. Paradoxically, in the context of radiation, less pleomorphic (clonal-appearing) cells may be malignant!
*Pleomorphism is often suggestive of malignancy. Paradoxically, in the context of radiation, less pleomorphic (clonal-appearing) cells may be malignant!


DDx:
DDx:
*[[Pleomorphic tumours]].
*[[Pleomorphic tumours]].
*Well-differentiated carcinoma, e.g. [[postradiation prostatic carcinoma]], may go unnoticed in the background of radiation-associated nuclear changes.
*Atypia associated with [[drug toxicity|drugs]].
*"[[Giant cell cystitis]]" - benign mesenchymal atypia with or without inflammation.
===Images===
====Rectum====
<gallery>
Image: Radiation proctitis - alt -- low mag.jpg | [[Radiation proctitis]] - low mag. (WC)
Image: Radiation proctitis -- intermed mag.jpg | Radiation proctitis - intermed. mag. (WC)
Image: Radiation proctitis -- high mag.jpg | Radiation proctitis - high mag. (WC)
Image: Radiation proctitis -- very high mag.jpg | Radiation proctitis - very high mag. (WC)
Image: Radiation proctitis - 2 -- intermed mag.jpg | Radiation proctitis - intermed. mag. (WC)
Image: Radiation proctitis - 2 -- high mag.jpg | Radiation proctitis - high mag. (WC)
Image: Radiation proctitis - 2 alt -- high mag.jpg | Radiation proctitis - high mag. (WC)
</gallery>
====Prostate gland====
<gallery>
Image: Prostate with radiation changes -- low mag.jpg | Prostate with RC - low mag.
Image: Prostate with radiation changes -- intermed mag.jpg | Prostate with RC - intermed. mag.
Image: Prostate with radiation changes -- high mag.jpg | Prostate with RC - high mag.
</gallery>
====Brain====
<gallery>
File:Glioblastoma-radiation changes HE.jpg | [[Glioblastoma]] with RC (WC/jensflorian)
File:Pathology Brain Radiation Necrosis 1.jpg | Radiation necrosis (WC/Tdvorak)
File:Pathology Brain Radiation Necrosis 2.jpg | Radiation necrosis and gliosis (WC/Tdvorak)
</gallery>
==IHC==
*Pankeratin -ve.
*KI-67 low.
==Sign out==
<pre>
RECTUM, BIOPSY:
- SQUAMOUS MUCOSA WITH MARKED ACUTE INFLAMMATION AND REACTIVE CHANGES.
- GRANULATION TISSUE.
- LARGE ATYPICAL STROMAL CELLS AND FIBROSIS, COMPATIBLE WITH THE HISTORY
  OF RADIATION TREATMENT.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
URINARY BLADDER, TRIGONE, BIOPSY:
- INFLAMED UROTHELIAL MUCOSA WITH SQUAMOUS METAPLASIA, ULCERATION AND
  GRANULATION TISSUE FORMATION.
- RADIATION CHANGES (STROMA).
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
</pre>
<pre>
Urinary bladder, biopsy:
- Urothelial mucosa with evidence of ulceration (fibrin,
  necroinflammatory debris), mild stromal atypia and chronic
  inflammation, compatible with radiation cystitis
- Negative for dysplasia
- Negative for malignancy
</pre>
===Micro===
Scattered rare large atypical cells with a preserved nucleus-to-cytoplasm ratio are present. Fibrosis is present.


==See also==
==See also==
*[[Radiation colitis]].
*[[Radiation colitis]].
*[[Radiation esophagitis]].
*[[Radiation changes in cervical cytology]].
*[[Radiation changes in cervical cytology]].
*[[Radiation changes of the endocervical epithelium]].
*[[Radiation oncology]].
*[[Endometrium post-ablation]].


==References==
==References==

Latest revision as of 21:36, 2 November 2016

Radiation changes
Diagnosis in short

Radiation changes. H&E stain.
LM cytoplasmic vacuolation (usually abundant), enlarged nuclei - but usu. normal NC ratio, no nuclear membrane irregularies, chromatin "smudgy", +/-multinucleation, +/-fibrosis (chronic change), +/-edema (acute change)
LM DDx pleomorphic tumours - esp. sarcomas, poorly differentiated carcinomas, drug/toxin effect, well-differentiated tumours in the background of radiation changes, "giant cell cystitis"
IHC Ki-67 low, pankeratin -ve (usu.)
Site pretty much anywhere
Clinical history history of radiation treatment/exposure - important for the diagnosis
Prognosis benign
Clin. DDx cancer recurrence, infection, new malignancy, post-surgical changes

Radiation changes, also radiation effects, are seen occasionally by pathologists. They are usually a result of prior (radiation) treatments. The history is important in making this diagnosis.

General

  • History of radiation treatment/exposure.
  • Clinical symptoms dependent on site.

Gross

  • +/-Erythema (early)
  • +/-Fibrotic appearing tissue (late).

Microscopic

Features:[1]

  • Cytoplasmic vacuolation - usually abundant.
  • Nucleus:
    • Enlarged nucleus - but normal NC ratio.
    • No nuclear membrane irregularies.
    • Chromatin: "smudgy".
    • +/-Multinucleation.
  • +/-Fibrosis (chronic change).
  • +/-Edema (acute change).

Important note:

  • The atypical cells are stromal cells; these survive the radiation. The epithelium is usually normal in the context of chronic changes.
  • Pleomorphism is often suggestive of malignancy. Paradoxically, in the context of radiation, less pleomorphic (clonal-appearing) cells may be malignant!

DDx:

Images

Rectum

  • Radiation proctitis - low mag. (WC)

  • Radiation proctitis - intermed. mag. (WC)

  • Radiation proctitis - high mag. (WC)

  • Radiation proctitis - very high mag. (WC)

  • Radiation proctitis - intermed. mag. (WC)

  • Radiation proctitis - high mag. (WC)

  • Radiation proctitis - high mag. (WC)

Prostate gland

  • Prostate with RC - low mag.

  • Prostate with RC - intermed. mag.

  • Prostate with RC - high mag.

Brain

  • Glioblastoma with RC (WC/jensflorian)

  • Radiation necrosis (WC/Tdvorak)

  • Radiation necrosis and gliosis (WC/Tdvorak)

IHC

  • Pankeratin -ve.
  • KI-67 low.

Sign out

RECTUM, BIOPSY:
- SQUAMOUS MUCOSA WITH MARKED ACUTE INFLAMMATION AND REACTIVE CHANGES.
- GRANULATION TISSUE.
- LARGE ATYPICAL STROMAL CELLS AND FIBROSIS, COMPATIBLE WITH THE HISTORY
  OF RADIATION TREATMENT.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

URINARY BLADDER, TRIGONE, BIOPSY:
- INFLAMED UROTHELIAL MUCOSA WITH SQUAMOUS METAPLASIA, ULCERATION AND 
  GRANULATION TISSUE FORMATION.
- RADIATION CHANGES (STROMA).
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Urinary bladder, biopsy:
- Urothelial mucosa with evidence of ulceration (fibrin, 
  necroinflammatory debris), mild stromal atypia and chronic 
  inflammation, compatible with radiation cystitis
- Negative for dysplasia 
- Negative for malignancy

Micro

Scattered rare large atypical cells with a preserved nucleus-to-cytoplasm ratio are present. Fibrosis is present.

See also

References

  1. ↑ Gupta, S.; Mukherjee, K.; Gupta, YN.; Kumar, M. (Aug 1987). "Sequential radiation changes in cytology of vaginal smears in carcinoma of cervix uteri during radiotherapy.". Int J Gynaecol Obstet 25 (4): 303-8. PMID 2887465.
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